Men can benefit from replacement hormones, too.
by Melissa Block
I don't know about you, but the idea of hormone replacement for men initially struck me as a bit over the top. I had an image of a guy pushing 50, having his back waxed and his forehead Botoxed and his abdomen liposuctioned, visiting the doctor for his hormone creams and injections (and his prescription for Viagra, not that he needs it, but just in case) before hopping into his shiny new convertible with his new trophy wife, having ditched the wife of 22 years and the kids as soon as he hit midlife crisis.
After I did some research, however, I found that male hormone replacement is far more than cosmetic. It can be every bit as practical as female hormone replacement. It can be instrumental in protecting a man against the diseases that are most likely to kill him or drastically reduce his quality of life, including heart disease, prostate enlargement, and prostate cancer. Judicious hormone replacement can bring back a man's flagging energy, boost depressed mood, and amplify waning sexual responsiveness and libido.
As a man ages, his body's production of androgens falls. With this change comes increasing incidence of age-related diseases. This trend is more than just coincidence; research is showing that replacing missing testosterone and DHEA can help to stave off diseases of the cardiovascular, nervous, and reproductive systems. Newer evidence indicates that progesterone may also be useful in male hormone replacement therapy.
Yes, there is a male menopause; it lasts a decade or more, because a man's hormone balance changes much more gradually than a woman's. Male menopause - more correctly known as andropause - is not the same thing as midlife crisis.
According to Marc Rose, MD, an ophthalmologist and male hormone replacement specialist in California: Andropause doesn't make a man want to go wild, but rather makes him want to take up permanent residence in his La-Z-Boy. It's a physiological change in hormone levels that saps his energy and potency. The midlife crisis, on the other hand, tends to be an emotional or psychological shift. In an attempt to escape unpleasant realizations about aging and mortality, some men 'act out' and have a last go at turning back the clock.
- From Dr. Rose's book, written with M.L. Block and Virginia Hopkins, A Woman's Guide to Male Menopause: Real Solutions for Helping Him Maintain Vitality and Virility, Keats Publishing, Los Angeles, CA :2000.
Male Hormones Throughout the Lifespan
Some hormones are masculinizing, and exist in much higher concentrations in men than in women; these are the androgens, and they include testosterone and dehydroepiandrosterone (DHEA). The estrogens - estradiol, estrone, and estriol - are their feminizing counterparts, found in many times higher concentrations in women than in men.
Then, there are a few hormones that aren't exactly female or male. Progesterone is one of them. Although it is widely regarded as a female hormone, progesterone doesn't feminize the male body in any way. In women, progesterone maintains healthy pregnancy, and in both sexes, it provides a much-needed balance for the proliferative (cell-growth-enhancing and potentially carcinogenic) effects of estrogens. Progesterone is influential throughout the body, promoting the health of the bones and cardiovascular system.
Human growth hormone (HGH) is a hormone that holds equal sway over both sexes. In both men and women, HGH production declines with passing years, and some amazing results - literally, turning back the clock on physical and mental aging - have been achieved with very careful supplementation of HGH, injected one or two times a day in tiny doses. Unfortunately, the expense of HGH replacement is prohibitive for most people, but you can increase your body's natural ability to produce this hormone by taking supplements that contain L-arginine, an amino acid. For more information, you may want to look at an FAQ article on the Prostate.
Testosterone for Male Health and Longevity
Production of testosterone decreases by about 1.5 percent per year after his 50's. At the same time, his production of sex hormone binding globulin (SHBG) rises, effectively binding up more of the testosterone in his body and making it unavailable for use by the tissues.
Testosterone is the hormone that kick-starts male puberty. It hardens and strengthens the muscles and bones, deepens the voice, and strengthens the ability of the heart to pump blood. It heightens libido, promotes HGH production, and contributes to the maintenance of an optimal ratio of fat to lean tissue. Testosterone also helps keep blood sugar and insulin properly balanced, lowers LDL cholesterol, and gives a man a general feeling of being able to hand out a bit of whoop-ass: confidence, energy, good mood.
Men who have low libido, low energy, or a sudden onset of depression in their 50's or later; who lose muscle and gain fat; and who lose body hair on the chest and genitals and grow excessive hair elsewhere may be deficient in testosterone.
A man with total blood levels of testosterone below 900 micrograms per milliliter (mcg/ml) and free testosterone below 30 mcg/ml may benefit from testosterone replacement. Natural testosterone can be obtained with a doctor's prescription; a patch that delivers the hormone transdermally is available. It may take a few rounds of checking levels and adjusting dosage to get the levels just right - at the median for a healthy 40-year-old man, between 900 and 1,200 mcg/ml total or 30-40 mcg/ml free testosterone.
Men with history of prostate cancer or testicular cancer should not use testosterone. Men who have BPH can try it, but start out with low doses to make sure it doesn't worsen the problem.
DHEA for Men
DHEA is converted to testosterone in the body, and can bring levels of testosterone back up into optimal ranges when used judiciously. It's available over-the-counter, which makes it more appealing to the "do-it-yourself" kind of guy. DHEA can also be converted to estrogens, though, and it's hard to know how it will be transformed in a person's body until he tries it. It should be used with care, and a doctor's supervision wouldn't hurt.
Striking correlations have been drawn between good health and high DHEA concentrations in the body. Blood levels fall after the age of 25 or so, and there's a lot of variation between the speed of DHEA decline between individuals. It seems that those whose DHEA remains higher for longer are less vulnerable to age-related diseases such as adult-onset diabetes, cardiovascular disease, and some cancers. DHEA users report pronounced feelings of well-being, and their immune function tends to improve. Studies show that DHEA enhances the clock-reversing effects of human growth hormone.
Men over 45 years of age can try 10 to 25 mg per day of DHEA for starters. It's a good idea to take periodic measurements of hormone levels - every six months or so - to ensure that the dose is correct. Go to hormone tests for men for more information on hormone testing.
As is the case with testosterone, men who have had or have testicular or prostate cancer should avoid DHEA.
Progesterone for Men
In aging men, progesterone is especially useful for balancing the effects of excess estrogens. The most common reasons for estrogen overload in men are overweight - fat cells transform testosterone into estrogens through a process called aromatization - and excessive exposure, over his lifetime, to xenoestrogens, powerful estrogen mimickers found in common chemical pollutants that turn up in our food supply. Xenoestrogens are also found in all petroleum products, including many plastics, fiberboard, pesticides, furniture, and carpeting. Lifelong exposure to these chemicals has, most likely, increased the number of estrogen receptors in the average man's prostate and elsewhere in his body.
A man of 65 tends to have much less testosterone and progesterone relative to estradiol than a man of 40, and this changing ratio strongly correlates with the development of benign prostatic hypertrophy (BPH). BPH causes frequent and/or painful urination, decreased libido and potency, urinary retention, and interruptions in the urine stream. Fifty percent of 50-year-olds, 70 percent of 70-year-olds, and 80 percent of 80-year-olds have BPH to some extent. Aromatase inhibitor drugs such as Arimidex help to prevent the transformation of testosterone into estradiol in the prostate, and this can help to reverse BPH. Balancing excess estrogens with small doses of progesterone can have similar effects.
An enzyme called 5-alpha-reductase transforms testosterone into a form called dihydrotestosterone (DHT), which has growth-promoting effects on prostate tissues. DHT also appears to be a cause of male pattern baldness (MPB). A drug called finasteride (Proscar) can be used to stop the T to DHT transformation, but a little bit of progesterone has also been reported to be helpful by physicians who have tried giving it to their male patients. Some have even reported that progesterone promotes hair regrowth in men with MPB!
Men who wish to try progesterone should use a transdermal gel that contains only USP pure progesterone and vitamin E. Use a brand that is formulated so that isn't too difficult to get a low dose of about 6 to 8 mg of progesterone per day such as Restore Balance Natural Progesterone Cream which has a little over 6 mg in one pump and can be found on this site.
Rub it onto the skin, rotating sites to avoid saturating the tissues in one spot. The progesterone will seep into the subcutaneous fat and slowly diffuse into the circulation.
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